Individual
DR. MICHAEL WADE JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Mailing address
187 BURT BLVD, STE A, BENTON, LA 71006-4905
(318) 935-5080
(318) 935-5085
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1590-623T
LA
Other
Enumeration date
08/06/2010
Last updated
11/16/2016
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